Spirit of Christmas - Part 5
by Melissa Rivers
Summary: It's Christmas in the ER and a few surprises abound


SPIRIT OF CHRISTMAS  
by Missy  
(missy@lexicon.net)  
  
DISLCAIMER: The characters of ER are the property of Michael  
Crichton, Warner Bros., Constant Productions and Amblin Television  
and the actors who so marvellously portray them.  
  
Any comments and/or constructive criticism will be gratefully received  
at the above e-mail address.  
  
PART 5/?  
  
"Jerry, could you please call for a cardiology consult for Emma Carides  
in Exam 2." Kerry asked as she returned to the desk.  
  
"Can we get some help." called out the paramedic as they raced the  
gurney through the emergency doors, a cold gush of air rushing in after  
them from the bleak winter's day, snow still falling gently to the ground.   
  
  
Kerry, Jeanie and Lily immediately stopped what they were doing and  
rushed to assist.   
  
"What have we got?" Kerry asked, moving alongside the trolley.   
  
"High fever with localised paralysis. There's two more still coming."   
  
"Jerry, page Doug and Mark stat! We've got another two coming."  
Kerry yelled back down the hall.  
  
They pushed the trolley into Trauma Two, Dr. Sam Cheung, Lydia and  
Meredith arriving in the room.  
  
"Seven year old girl. Devi Ramesh. Pulse is 150, BP's 60 palp, temp  
103F, paresis of the lower extremities, good breath sounds bilaterally."   
  
"My count. One two three." They lifted the child across gently. "CBC,  
Chem-7, ABG, blood culture, chest film by two."  
  
The paramedics moved the trolley out of their way, handing Sam the  
chart as they left. Kerry placed her stethoscope on the child's chest  
checking the breathing.  
  
"BP's 65 palp, pulse 155." Lily informed them.  
  
Lydia attached the pulse ox monitor to the girl's finger. " Pulse ox is  
down to 90"  
  
"Get a mask on her." Sam instructed.  
  
"Temps 104" Jeanie said as she checked the girl's eyes. "Pupils are  
equal and reactive."  
  
"Two units of saline and an amp of dopamine, IV infusion. Jeanie, get  
a focused H&P from the relative" Kerry indicated at the lady staring  
anxiously through the glass window of the swinging doors. Placing her  
stethoscope back around her neck. " Sputum AFB, C&S, lytes, UA,   
guiac culture and prepare for a spinal tap."   
  
Sam checked the reflexes in the arms and legs. "Diminished deep  
tendon reflexes in the legs."  
  
"Check for Kernig's sign." Kerry instructed watching as Sam performed  
the manipulation of the thigh and knee.   
  
"Absent."  
  
"And no photophobia." Kerry commented, flicking her light in the  
child's eyes for a response making sure there was no sensitivity to the  
light.  
  
- 0 0 0 -  
  
"What have we got?" Doug asked as he ran into Trauma One,  
questioning Maggie as she listened to the young girl's chest.  
  
Doug checked the girl's breath sounds as Maggie gave him the bullet.  
  
"Nine year old girl. Malika Ramesh. Pulse 155, temp of 105F, altered,  
paralysis of all four extremities and diminished breath sounds." Maggie  
replied succinctly. "I've ordered CBC, Chem-7, ABS, blood culture and  
chest film by two"  
  
"BP's 60 palp. Resps 32." Kate informed him, placing her stethoscope  
back around her neck for easy access.  
  
"Okay, let's tube her. Intubation tray. Size 6.5 ET tube. Five migs of  
norcuron." Doug instructed. "Two units of saline and five mics per kilo  
ativan IV infusion."   
  
Vikash attempted to get a line in the girl's veins. "I can't get a line."  
  
Maggie also gave an attempt to get a line but the child's veins just kept  
collapsing. "We need to do a J-line." Maggie said to Doug. The girl's  
high temperature had caused a loss of circulation, resulting in them being  
unable to be able to use the veins in her arms to insert the IVs.  
  
"Do it."   
  
Maggie immediately took action, inserting the needle into the jugular  
vein to enable them to put in the IV fluids and medications. Taping the  
needle in place securely, Maggie was about to give the girl the norcuron  
when she began seizing.  
  
"Roll her on her side. Ten mics per kilo dilantin stat." Doug instructed  
as they held the girl in coma position, waiting for the drug to take effect  
and reduce the seizing. Once settled, they rolled her back on her back  
and Maggie checked her breathing again. "I'm losing breath sounds."  
  
"Lets tube her. Get a vent and portable chest down here now!" Doug  
called out moving to the girl's head. Kate passed him the laryngoscope  
to insert the tube down the child's trachea. As he was intubating the girl,  
the staff passed the bags of saline and medication, checking dosage  
before administration. Malik left to chase down a ventilator to hook the  
girl up to.  
  
- 0 0 0 -  
  
Kerry came out of Trauma Two, letting the doors swing shut after her.   
After seeing the condition of the girl, she wanted to get the background  
information from Jeanie to be sure that she was correct in her diagnosis.   
As she passed Trauma Two, Doug was just leaving his own patient.   
  
"Jeanie's getting a focused H&R. The girl has lower extremity paralysis  
and fever. I had Lydia hand carry the labs."`  
  
"What's her mental status?"  
  
"She's altered, going in and out of consciousness. She doesn't appear  
to speak English."  
  
"Vikash said it's Tamil. He recognised it from some of the words but he  
doesn't speak Tamil himself." Doug commented. "I've had to intubate.   
She's got total paralysis of all four extremities affecting respiration.   
Fever of 105 and she's suffered a seizure."  
  
"There's no sign of photophobia or Kernig's?" Kerry asked. These were  
the presenting symptoms seen in cases of meningitis which would be the  
obvious cause of such a presentation.   
"No. There is nystagmus though."   
  
Kerry looked at Doug sharply, her jaw tensing as this further confirmed  
her suspected diagnosis. As soon as there was no photophobia or  
Kernig's sign, she had begun to suspect but did not wish to allow her  
personal experiences to cloud her judgement. Her pace faltered slightly,  
enough for Doug to notice.  
  
"You suspected polio also?" asked Doug surprised. "Well, the spinal tap  
will tell us for sure." He did not need to question whether Kerry had  
done one. In a case of meningitis or poliomyelitis, which was what they  
suspected, a spinal tap was the chief confirmation of diagnosis.  
  
As they approached the admit area, Jeanie and the relative turned before  
coming to meet them.  
  
"How are they?" asked the woman, her Indian accent flavouring her  
words.  
  
"We have stabilised the children for the moment but we need to find out  
what caused their illness." Doug informed her.  
  
"Mrs. Sohani says that her sister, niece and nephew arrived from India  
nine days ago. They were fine at the time of arrival. Three days ago  
they began complaining of nausea, headaches and pains in their limbs.   
They all had a slight fever yesterday. This evening, they woke with  
paralysis and high fever."  
  
"That's when I called 911." Mrs. Sohani nervously interjected, worried  
by the seriousness of her their condition. "I didn't realise they had  
anything other than the 'flu."  
  
"Mrs. Sohani, has your sister or the children been in contact with anyone  
who has had polio or been vaccinated against polio in the past few  
weeks?" Kerry asked, cutting short her guilt.  
  
There were two ways in which polio could be contracted, either from an  
outbreak in an unvaccinated country, such as India, or by being  
unvaccinated and coming into contact with a child recently vaccinated  
against the disease, mainly through bad hygiene practices.  
  
"Polio. You think it may be polio?" Mrs. Sohani looked shocked.  
  
"It is a possibility." Kerry replied gently.  
  
"Umm, my children have had no vaccinations recently. Does that mean  
my children could get it?" Mrs. Sohani was frightened by the prospect.  
  
"At the moment, we are still trying to diagnose your sister and her  
children. It would help if you could tell us if they had been in contact  
with anyone with the disease before arriving." Doug kept his voice firm  
and calm, directing the conversation in the direction he wanted, to get the  
answers to his questions.  
  
"I'm not sure about before they came to America. We didn't talk about  
anything in particular. You think they may have got it there? But that  
was over nine days ago."  
  
"The incubation time for polio is anywhere between seven to twenty-one  
days. We are waiting on some lab results to come through to confirm  
our suspicions. What I would like you to do is make a list of all the  
people they have been in contact with since arriving in America. Jeanie  
will help you." Doug guided the woman to a chair, making sure she kept  
focussed positively on assisting them.  
  
" Make up a list with Mrs. Sohani, of all the people who have been in  
contact with the children and their mother since arriving in America.   
Also make a note of the type of contact, whether they have eaten at the  
home etc." Kerry spoke quietly to Jeanie, leaving her to take care of the  
situation.   
  
As she passed the work station, she paused. "Randi, could you chase up  
those lab results on the Ramesh children. I also need you to make an  
exam room ready for quarantine procedures for three patients. Jerry, I  
need you to get the Department of Health on the phone. Page me when  
you've got them."   
  
Doug caught up with Kerry as they went back to the trauma rooms.  
  
"Have you ever treated a case of polio before?" Kerry asked.  
  
"One VAPP case but no others? What about you?"  
  
"An epidemic in Africa but never here." They stopped outside the doors  
of the trauma rooms  
  
"We need to reduce their temperatures." Doug commented.   
  
Kerry nodded in agreement. "I've also found it beneficial to split the  
affected limbs to ensure stability of the area. There is a much better  
chance of recovery of function. Other than that, it's only supportive  
care."  
  
"Doug, Kerry. About this case....." Mark came towards them from  
Exam Room One.  
  
"Poliomyelitis" came Doug's short answer before Mark could continue.   
"We're waiting for the results of the spinal tap but it pretty much looks  
like it. The symptoms fit."  
  
"Polio?"  
  
"It looks like it has been Imported from India. Family arrived nine days  
ago."   
  
"Have you contacted the Heath Department?"  
  
"Jerry's onto it right now. CDC will also need specimens for virus  
isolation by two and another in twenty-four hours. Jeanie's with the  
sister making a list of possible contacts. We will also need to isolate  
them and warn all staff that quarantine procedures are in force for the  
three patients." Kerry went into Trauma Two to begin the supportive  
management of her patient and to arrange quarantine procedures.  
  
"How's the mother?"  
  
"She's stable. Only partial paralysis of the legs, temps 103."   
  
"Keep the temp. down and Kerry also suggested splinting the legs for  
maximum rest and recovery." Doug threw in as he was about to return  
to Trauma One.  
  
"She would know."  
  
"She doesn't talk about it much." Doug paused, his hand resting on the  
swinging door, turning around to face Mark.  
  
"You know how she tries to forget her disability." Mark flicked through  
his own lab results.  
  
"What? I was talking about her time in Africa. I'd always assumed that  
it was due to a car accident. I never really gave it much thought."   
  
"No. Most people don't. Kerry has worked hard to make us all forget.   
We tend to either respect her abilities or want to throttle her at some time  
or another."  
  
Randi came down the hall. "I've got those initial lab results." She  
handed over the charts to Mark. "Kate's getting Exam Three ready for  
quarantine."  
  
"Where's Dr. Weaver?"  
  
"Trauma Two." Mark indicated, handing back the results for Kerry's  
case. "Give Kerry her results."  
  
Randi went into Trauma Two . "Dr. Weaver. We're having trouble with  
the Department of Health. The operator doesn't want to contact the  
Department Official without proper authorisation. Here's the prelim.  
lab results."  
  
"Okay, put the call through to here and I'll give the authorisation."   
  
Randi left to put the call through. While she was waiting, Kerry looked  
through the results noting the confirmation she needed. The phone  
buzzed as the call was patched through.  
  
"This is Dr. Weaver of County General Hospital, ER Department. I have  
three suspected cases of poliomyelitis. Put me through to a Health  
Inspector now!"   
  
The tone of her voice should have conveyed the urgency of the matter.   
However, it appeared that the operator did not even realise the  
ramifications of a polio outbreak. Kerry waited while the operator  
argued that it was after 5.00 p.m. and the inspector could only be called  
on emergencies.  
  
"Under CDC guidelines, this is an emergency. Either put me through  
to an inspector or your department supervisor. Now!"  
  
The word supervisor seemed to get the reaction she wanted. It was  
amazing how many people felt threatened when they thought their job  
could be on the line. She waited as she was put through.  
  
"Yes. This is Dr. Weaver of County General Hospital. We have three  
suspected cases of poliomyelitis."   
  
The health officer queried whether she was sure and the way in which  
the patients contracted the disease.  
  
"Live. It would appear to have been imported from India." she  
responded.  
  
There were three different types of poliomyelitis and the health officer  
needed to know the extent in which the patients were infected.  
  
"Two spinal, one bulbospinal. CDC recommendations and quarantine  
procedures are being implemented. We are in the process of trying to  
establish contacts and reduce transmission."   
  
"Assistance would be appreciated." Kerry knew that it would be  
necessary for the Department of Health to implement an investigation to  
prevent an epidemic occurring in the area. It would not require a shut  
down of the ER Department due to the means of transmission being only  
through direct contact, especially through bad hygiene procedures.  
  
- 0 0 0 -  
  
  
"Where's Dr. Weaver" Craig Goldberg asked brusquely as he came to  
the central work station, demanding the information from Randi who  
was taking down details from a patient. He grew impatient when he  
didn't gain her attention immediately, trying to intimidate her with his  
height and presence, moving from one foot to the other in frustration.  
  
Randi was unperturbed by his attitude and calmly finished with the  
patient before turning her attention to him. "She's in Trauma Two with  
the polio case."  
  
He strode off purposely in that direction and met Kerry in the hall as they  
were transferring the patient down to Exam 3, which had been set up for  
quarantine.   
  
"Why have I received calls from the Department of Health and CDC?"   
He asked indignantly, still smarting over his ignorance when the calls  
had been put through to his office.  
  
"We've got three polio cases." Kerry replied. "Sam, could you take her  
down to Exam 3." She handed him the chart.  
  
"Right, Dr. Weaver." Sam replied, guiding the trolley past the two  
doctors.  
  
"Why wasn't I informed? I am the Chief of Emergency Services and you  
should have contacted me immediately." His resounding voice vibrated  
in the hall, heads turning to see just who was being chewed out.  
  
"Which I did. I know the procedures in a case such as this and I  
followed it. However, you were unavailable to take the call. Now, I  
have a job to do down here and I cannot be waiting for you to be  
available to take a call." Kerry's voice was sarcastic and she was  
determined she was not going to be bailed out for doing her job.  
  
Before Craig could respond, Randi interrupted them. "I've got a rep.  
from the Department of Health here."   
  
"Thanks Randi." Kerry turned to Craig. "We've got back the lab results  
and set up quarantine in Exam 3. Historicals have been conducted for  
follow-up by the DOH and full CDC procedures have been  
implemented."  
  
Craig's eyebrows lifted a notch in surprise that she had so swiftly  
provided him with the information needed to deal with the Department.   
"Well, it seems that you have fulfilled the necessary requirements.   
However, next time you might insist on being put through."  
  
"It might be an idea to inform your secretary of what constitutes an  
emergency." Kerry retorted as she left him to deal with the department  
official.  
  
END PART 5/? 


End file.
